Strategic equipment planning for the outpatient environment: a practical guide to equipment planning for ambulatory construction.
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Ambulatory Care Information Systems↗
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Results for “practice environment”
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Preoccupation with health or an ideal environment to practice family medicine?
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Family Practice↗
Policy and practice. Supportive environments.
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Acquired Immunodeficiency Syndrome↗
Case management: the relationship between structure & environment.
In response to increasingly uncertain practice environments, case management structural dimensions of role differentiation, task coordination, and decentralization remained constant, while nurse participation in decision making increased significantly.
Decision Making, Organizational↗
The changing role of advanced practice nursing in a managed care environment.
Advanced practice nursing in a managed care environment--is this an oxymoron? Can these two phrases exist together? Do advanced practice nurses have a role in a managed care environment? As health-care systems continue to merge and managed care impacts the bottom line, advanced practice nurses are challenged to show their worth. In this article, the author reviews the impact managed care has had on the roles of two master's-prepared traditional clinical nurse specialists. Included are examples of how the roles were adapted to fit in the managed care setting. The current role of the advanced practitioners is reviewed, using the common subroles as a basis for discussion. The impact of managed care on each component of the clinical nurse specialist role is identified. The author also demonstrates that advanced practice nurses can have a valuable role in the managed care environment.
Critical Care↗
Neurosurgical practice in the current regulatory environment.
The practice of neurosurgery has been complicated over the last 25 years by the enactment of a series of statutes that have significantly altered the time-honored means by which neurosurgeons manage their work. These laws deal with issues that neurosurgeons have not customarily had to consider. The author outlines some of the socioeconomic and political matters that led to the passage of these statutes. An assortment of the laws is then surveyed, to foster an appreciation for the variety and depth of health care law that affects neurosurgeons' practice and the delivery of care to their patients. Statutes discussed include the fraud and abuse laws, self-referral laws, the Emergency Medical Treatment and Labor Act, Health Insurance Portability and Accountability Act, and Employee Retirement Income Security Act.
Fraud↗
The mismatch between evidence and practice. Common therapies in search of evidence.
Many therapies in neonatology persist without supportive evidence: some common therapies may actually be harmful. Evidence-based medicine is the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The best available evidence, however, is not always sound or valid evidence. Sometimes, when faced with a collection of reports that do not constitute good evidence, attempts to choose the best evidence become pointless; in this case, a statement of no good evidence is preferable. There is a continuing problem with the place of usual practice in the hierarchy of evidence; usual practice generates experience with a particular practice but no reliable information regarding how the practice compares with alternative strategies. Although clinical and institutional inertia combined with a litigious practice environment tend to uphold current practice, the field of neonatology is ripe with examples of established therapies that were subsequently shown to be harmful. It is important to focus on important long-term outcomes and as much on the possibility of harm as on the chance of benefit, especially for new therapies, before they become routine practice. In the face of inadequate evidence, it is particularly important to avoid the temptation to institute treatment guidelines that inhibit further research. Patients are better served by guidelines that recommend only strategies that are supported by strong evidence and recommend further research when the evidence is inadequate.
Evidence-Based Medicine↗
Valuing both critical and creative thinking in clinical practice: narrowing the research-practice gap?
BACKGROUND: Nurturing critical thinking skills in the classroom is considered an important educational activity. It is believed that critical thinking skills are transferable and that they can be applied in practice when appraising, evaluating and implementing research. That more nurses than ever before have been judged academically knowledgeable in research has not guaranteed the transfer of such knowledge to practice. AIM OF THE PAPER: This paper discusses some of the reasons for the failure to narrow the gap between research and practice. In particular we argue that, if nurses are encouraged to develop creative and generative thinking alongside their critical thinking skills, then the art of nursing will have fuller representation in education, research and practice. DISCUSSION: The successful development of critical thinking skills for academic purposes does not necessarily mean that these skills are used in practice in relation either to research or clinical decision-making. This suggests that the transferability of critical thinking skills is less than straightforward. Indeed, there has been little narrowing of the research-practice gap since students started to learn critical thinking for academic purposes. However, we propose that thinking skills can be encouraged in the context of practice and that regular educational events, such as journal clubs, can contribute to developing critical thinking in the practice environment. CONCLUSIONS: The research-practice gap will reduce only if research becomes part of practitioners' ideology, which includes the art and science of nursing. Critical and creative thinking are prerequisites to narrowing the disjuncture between research and practice, and we suggest that educators and practitioners explore structured ways of meeting together to appraise literature as a possible means of making use of their thinking and knowledge in clinical practice.
Clinical Competence↗
Dimensions of retention: a national study of the locational histories of physician assistants.
This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice. Through a survey, physician assistants listed all the places they had practiced since completing their physician assistant training, making it possible to classify the career histories of physician assistants as "all rural," "all urban," "urban to rural" or "rural to urban." The study examined the retention of physician assistants in rural practice at several levels: in the first practice, in rural practice overall and in states. Physician assistants who started their careers in rural locations were more likely to leave them during the first four years of practice than urban physician assistants, and female rural physician assistants were slightly more likely to leave than men. Those starting in rural practice had high attrition to urban areas (41 percent); however, a significant proportion of the physician assistants who started in urban practice settings left for rural settings (10 percent). This kept the total proportion of physician assistants in rural practice at a steady 20 percent. While 21 percent of the earliest graduates of physician assistant training programs have had exclusively rural careers, only 9 percent of physician assistants with four to seven years of experience have worked exclusively in rural settings. At the state level, generalist physician assistants were significantly more likely to leave states with practice environments unfavorable to physician assistant practice in terms of prescriptive authority, reimbursement and insurance.
Adult↗
[What do dental students think about their future career practice? Differences between men and women].
Aim of this study was to get more insight into the career choice, plans and expectations, and practice pattern preferences of male and female dental students in The Netherlands. A structured questionnaire was sent out to all 5th year dental students in The Netherlands in the academic year 2001/2002 (n = 258). The overall response was 65%. Both male and female students prefered working in a group practice environment rather than a solo practice, in which significant more males prefered ownership. Only 23% of the males and 7% of the females expected to work full time in the future. An important factor was leisure time, but for the female students 'taking care for children' was still decisive. The new job description 'oral physician' for the future dentist as advocated by Dutch health authorities was found less attractive than the present profession 'dentist'. Only a quarter of the females and half of the males is interested to serve as manager of a team of dental health professionals. It is concluded that male and female dental students differ in their plans and expectations with respect to their future career choices and practice pattern preferences. As the majority of the present dental students is female this will have a major impact on the dental profession.
Adult↗
Creating a successful environment for neonatal nurse practitioners.
Factors that contribute to the neonatal nurse practitioner (NNP) practice environment have emerged from research grounded in the results of a nonexperimental, descriptive, and correlational study that described the role and nursing identity of 258 NNPs. These factors may be used as prescriptions for developing successful NNP environments or to strengthen a current practice. Nursing management has a responsibility to identify factors that enhance nursing identity of NNPs and to plan strategies to operationalize those factors to provide an optimal environment in which NNPs can practice to their fullest potential. Implications are raised for nursing administration and education to address the issues of role differentiation, socialization, and identity of advanced practice nurses in tertiary care.
Humans↗
Transitions in pharmacy practice, part 3: effecting change--the three-ring circus.
The prerequisites for a change in practice in individual pharmacists, as framed by the Holland-Nimmo practice change model, are discussed. The Holland-Nimmo practice change model comprises three components, all of which must be addressed by a pharmacy's leadership if a change in practice is to be achieved. The first component is the practice environment, which must be conducive to implementation of the new form of practice. The second component is the availability of appropriate training for individual practitioners. The third component is an appropriate set of motivational strategies to be applied by the manager. All three components must be present at the same time; no one or two components by themselves are sufficient. The practice change model is equally applicable to pharmacy department managers in health-system settings and to community pharmacy owners and managers. To maximize the potential for individual pharmacists to change their practice, managers must create an environment conducive to the new form of practice, identify needed learning resources, and motivate practitioners to change.
Humans↗
Educational programs in US medical schools, 1993-1994.
From the data on faculty, students, and curriculum, is it possible to identify any responses to actual or anticipated health system changes? While one could foresee medical school downsizing in response to a potentially more competitive environment in which income from faculty practice would be reduced, what has occurred, on average, is steady growth in the number of faculty members across departments, with a large increase in the past year. However, expansion is not consistent across states. Between 1992-1993 and 1993-1994, the number of full-time faculty members decreased 1.5% in California medical schools, increased 3% in Minnesota medical schools, increased 6% in North Carolina medical schools, and increased 10% in New York and Pennsylvania medical schools. These differences may reflect the fiscal situation at the state level as well as differences in the practice environment in different areas. For example, managed care has not had a major effect in many markets. It will be important to monitor trends in faculty at both the national and regional levels to understand the full impact of health system changes. There is considerable diversity among US medical schools: in goals, in student profiles, and in curriculum structure. A number of schools have goals or objectives that contain a reference to the training of primary care physicians. The majority of these are public institutions, but a number of private schools have chosen to address the issue as well. Many schools, both public and private, are under external scrutiny related to the performance and specialty and practice location choices of their graduates.(ABSTRACT TRUNCATED AT 250 WORDS)
Accreditation↗
Differences in resource use and costs of primary care in a large HMO according to physician specialty.
OBJECTIVE: To determine if primary care physician specialty is associated with differences in use of health services. DATA SOURCES: Automated outpatient diagnostic, utilization, and cost data on 15,223 members (35-85 years of age) of a large group model HMO. STUDY DESIGN: One-year prospective comparison of primary care provided by 245 general internists (GIMs), 60 family physicians (FPs), and 55 subspecialty internists (SIMs) with case-mix assessed during a nine-month baseline period using Ambulatory Diagnostic Groups. PRINCIPAL FINDINGS: Adjusting for demographics and case mix, patients of GIMs and FPs had similar hospitalization and ambulatory visit rates, and similar laboratory and radiology costs. Patients of FPs made fewer visits to dermatology, psychiatry, and gynecology (combined visit rate ratio: 0.86, 95% CI: 0.74-0.96). However, they made more urgent care visits (rate ratio 1.19, 95% CI: 1.07-1.23). Patients of SIMs had higher hospitalization rates than those of GIMs (rate ratio 1.33, 95% CI: 1.06-1.68), greater use of urgent care (rate ratio: 1.14, 95% CI: 1.04-1.25), and higher costs for pharmacy (cost ratio: 1.17, 95% CI: 0.93-1.18) and radiologic services (cost ratio: 1.14, 95% CI: 1.01-1.30). The hospitalization difference was due partly to the inclusion of patients with specialty-related diagnoses in panels of SIMs. Radiology and pharmacy differences persisted after excluding these patients. CONCLUSIONS: In this uniform practice environment, specialty differences in primary care practice were small. Subspecialists used slightly more resources than generalists. The broader practice style of FPs may have created access problems for their patients.
Adult↗
The Joint Venture Model of Knowledge Utilization: a guide for change in nursing.
Knowledge utilization (KU) is an essential component of today's nursing practice and healthcare system. Despite advances in knowledge generation, the gap in knowledge transfer from research to practice continues. KU models have moved beyond factors affecting the individual nurse to a broader perspective that includes the practice environment and the socio-political context. This paper proposes one such theoretical model the Joint Venture Model of Knowledge Utilization (JVMKU). Key components of the JVMKU that emerged from an extensive multidisciplinary review of the literature include leadership, emotional intelligence, person, message, empowered workplace and the socio-political environment. The model has a broad and practical application and is not specific to one type of KU or one population. This paper provides a description of the JVMKU, its development and suggested uses at both local and organizational levels. Nurses in both leadership and point-of-care positions will recognize the concepts identified and will be able to apply this model for KU in their own workplace for assessment of areas requiring strengthening and support.
Attitude of Health Personnel↗
Comparing selection criteria of residency directors and physicians' employers.
In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.
Academic Medical Centers↗
A community collaborative practice experience between Med/Peds and family practice.
PURPOSE: The medical literature has followed educational outcomes of Medicine-Pediatric (Med/Peds) physicians, but limited studies exist as to clinical outcomes for these combined specialty physicians. Although a variety of practice environments are available for a growing number of Med/Peds physicians, a collaborative practice setting with family physicians may optimize the Med/Peds practice potential. This study investigates clinical practice outcomes and utilization efficiencies of collaborative Med/Peds family practice physicians within a community, which should provide an effective model in a growing managed care environment. PATIENTS AND METHODS: Two collaborative practice settings in a moderate size Midwest community were analyzed with respect to patient demographics and utilization scores provided by a practice management group and a nationally based health care network. Current Procedural Terminology (CPT) coding was used to follow demographic trends for over 45,000 patient visits for 1 year. Efficiency ratings (Z-scores) were used over the same year for over 6,000 health care network patient visits to 10 collaborative practice-based physicians, which were then compared to 141,101 community family practice patient encounters, 26,617 general internist patient encounters, and 29,995 patient encounters to pediatricians for utilization trends. RESULTS: Med/Peds and Family Practice patient care data reflected nearly identical patient demographics between specialties with only a few exceptions. Med/Peds physicians cared for three times the total number of children less than 2 years old. Med/Peds physicians experienced a higher complexity of illness, in part due to a 40% increase in internal referrals from family practice colleagues in the ambulatory care setting, while maintaining a third of the proportion of outpatient referrals. Cost-effective interoffice utilization was still maintained, supported by a more optimal efficiency rating for Med/Peds physicians compared to collaborative family practice colleagues. Inpatient efficiency was demonstrated for Med/Peds specialists even though a threefold increase in hospitalizations was observed, in part resulting from physicians within these collaborative practices arranging all newborn nursery and pediatric admissions be covered by Med/Peds physicians. Both collaborative primary care specialists demonstrated more cost-effective overall practice utilization scores when compared to community-based primary care specialists. CONCLUSIONS: Med/Peds physicians in this study have been trained to provide cost-effective patient care in both outpatient and inpatient settings. Decreased outside referrals by collaborative family practice physicians through utilization of Med/Peds colleagues serves to optimize practice economy by eliminating the threat of competition that exists among community-based generalists. Such a model helps to control an overused referral system to subspecialists.
Community Health Services↗